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General NPI Number Information
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NPI Number | 1801819792
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Entity Type | Organization
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Legal Business Name | DAVES SUPERMARKET INC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 3565 RIDGE RD
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City | CLEVELAND
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State | OH
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Zip | 44102-5443
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Country | US
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Telephone | 216-961-2005
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Fax | 216-631-1544
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Provider Business Mailing Address
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Address Line | 3565 RIDGE RD
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City | CLEVELAND
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State | OH
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Zip | 44102-5443
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Country | US
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Telephone | 216-961-2005
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Fax | 216-631-1544
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. DENNIS J ELLER
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Credential | RPH
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Telephone | 216-961-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02-0748900
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License Number State | OH
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